Make a new claim

Claim form

New claim

To make a claim, we recommend that you complete one of our forms, not one from the Jobcentre or Pension Service. This is because their forms often don't contain all of the information we need and we might require you to complete our form instead.

We may also accept a letter from the claimant but would strongly recommend completing the full claim form to reduce the chances of any delay.

Required Information and evidence

We will require information and evidence with the claim to make it valid. Included in the claim form is an employer's proof of earnings form and a landlord's proof of rent form. If you are self employed, please complete your own earnings declaration:

The following guide will help you complete your earnings declaration:

I need help completing the forms

Please contact us for advice.

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Restarting a claim

If you have had a claim in the past 26 weeks or less, and wish to restart your claim based on the same circumstances after your employment has ended, please see restart a claim.

If more than 26 weeks have passed or your circumstances have changed, you will need to start a new claim.

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Information and evidence required

For a claim to be valid it must be accompanied by documentary evidence and information to confirm the identity, National Insurance number, income, capital, residency, rent and household composition of the claimant and their partner (if applicable) and their family.

If you do not have a National Insurance number, or do not know what your number is, then please refer to the National Insurance (NI) number information - on the HM Revenue & Customs section of the website.

We are only able to accept original documents (not photocopies). If you bring documents to the Shoreham Centre or Portland House we will photocopy them immediately and give them back to you. If you send documents by post, we will photocopy them and return them to you the same day.

It is very important that all the information and evidence requested on the form is provided at the time the application is submitted. The most common reason for claims being delayed is because information and evidence has not been provided with the form.

Please check what evidence and information we will require when making a claim.

If we do not receive proof within one month, we will cancel your claim.

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Contact details

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Contact Details

Contact details

Adur Benefits

Telephone01273 263444 (9am to 5pm, Mon to Fri)

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Full contact detailsFull contact details (Adur Benefits)

Worthing Benefits

Telephone01903 221062 (9am to 5pm, Mon to Fri)

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Full contact detailsFull contact details (Worthing Benefits)

Need Assistance?

Need assistance?

Get in touch

Page last updated: 17 September 2018